1) Field of the Invention
The invention relates to modifying the electrocardiograph and a new method to record electrocardiograms by placing the electrodes on areas were the potentials of each of the heart structures are prevalent and pairing them with an electrode placed on the left leg. The use of the common electrode, in contrast to today's art of changing the polarity and using two, three, or four electrodes per lead, facilitates the recognition of the normal electrocardiogram, the abnormal pathological changes and the genesis of such anomalies.
2) Description of the Related Art
In 1,888, Augustus Desire Waller recorded the first electrocardiographic trace by immersing his assistant hands in containers with water connected to a mercury electrometer. Later the containers were filled with a saline solution. The two arms and the left leg were immersed in three separate containers and three leads were recorded connecting the leg to each arm and then the two arms together. The positive terminal of the mercury electrometer was connected to the leg and the arms to the negative terminal to record Lead II and Lead III and the left arm was connected to the positive terminal and the right arm to the negative terminal to record lead I. This arrangement is still done today (15. Waller, 1888; 751-754).
In 1,906, Wilhelm Einthoven invented the string galvanometer and the recordings became accurate and standardized. Since the detected electrocardiographic signals are in the range of 1 to 2 mV the recordings were obtained at a sensitivity of 10 mm/mV and a speed of 25 mm/sec. a standard still in effect today (1. AHA 1938, recommendation 5). By 1913 Einthoven, Fhar and de Waart demonstrated the mathematical relationship between the three leads III=II−I (4. Einthoven, 1913, in Am. Heart J. 1950, page 172 paragraph 48), known today as Einthoven's Law, and introduced the assumption of the Equilateral Triangle and the Central Dipole to calculate the electrical axis of the heart. With time Einthoven's assumption became known as today's Einthoven's Theory of the Equilateral Triangle and it's Rotating Central Dipole (4. Einthoven, 1913, in Am. Heart J. pages 175-176, FIG. 17, paragraphs 60-63; 3. AHA, 2007, page 1117, col. 1, lines 2-16).
Since the times of Waller to the mid-seventies the electrocardiographs had only one amplifier and a dial to select the lead to be recorded at the same sensitivity and speed established by Einthoven in 1913. The connecting cables of those electrocardiographs were color-coded: white to the right arm; black to the left arm; red to the left leg; green to the left leg (ground electrode). On 1,938 the Joint Recommendations of the American Heart Association and the Cardiac Society of Great Britain and Ireland, on page 108 the fifth recommendation establishes that any change in the sensitivity of one centimeter per millivolt should be recorded on the trace (1. AHA 1938, fourth paragraph of page 108). In the article Standardization of Precordial Leads, on page 235 third paragraph, establishes the placement of the chest leads, CF or V followed by a subscript number to designate the site of placement (2. AHA1938, third paragraph of page 235). The AHA in the article published in 1967 describes the requirements of the Direct-Writing Electrocardiographs (3. AHA 1967, page 585, col. 2, line 14), were the Gain of the electrocardiograph is reaffirmed (3. AHA 1967, page 586, col. 1, line 19-col. 2, line 12) The electrocardiographs then had a brown connecting means to be connected with the chest electrode placed on each of the specific sites of the chest. The selecting switch of the electrocardiograph connected the respective electrodes to record the desired lead. After the late sixties the CR, CL, and CF leads, that were considered bipolar leads, were eliminated.
In 1934, Frank N. Wilson et al. proposed that by joining three resistances of 5,000Ω in a junction, labeled Central electrode, and the other end of the resistances connected to the three extremities, based on Einthoven's theory and Kirchhoff's First Law, the electrical potential of the junction of the three resistors is equal to zero and so leads connected to the junction are unipolar. They introduced the nine unipolar leads known as VL, VR, VF, V1, V2, V3, V4, V5, and V6 recorded by connecting the negative terminal of the amplifier to the central terminal and the positive terminal to the extremity to be investigated or to the chest electrodes (17. Wilson et al. 1934, equations 1-16). Today the three extremity leads, VL, VR, and VF are not recorded, (4. AHA, 2007, page 1115, col. 2, lines 33-36; col. 2, line 55-page 1116, line 3; page 1117, col. 2, lines 3-14 and lines 30-33).
In 1942, E Goldberger found that by eliminating Wilson's resistances and just connecting two extremities together to form a central electrode and connecting that junction to the third extremity the amplification of Wilson's extremity leads was increased by one half. He called these leads, the Augmented Unipolar Leads aVr, aVI and aVf. This was possible since, according to him, his three different central electrodes have a potential equal to zero too (6. Goldberger, 1942, equations on page 486). He preserved the polarity of Wilson's leads, negative terminal connected to the junction, positive terminal connected to the third extremity (6. Goldberger, 1942, page 485, FIG. 3). Today's electrocardiographs do not record Goldberger's leads; they are calculated from two recorded Einthoven leads (4. AHA, 2007, page 1117, lines 14-30).
All of today's electrocardiographs record at a sensitivity of 10 mm/mV. In special circumstances it can be halved, 5 mm/mV or doubled, 20 mm/mV. At the beginning of the tracing, the electrocardiographs show a square deflection showing the sensitivity. The sensitivity and the speed of the tracing is also printed at the bottom of the report. The standard speed been 25 mm/sec. can also be halved or duplicated in special cases. Einthoven set the sensitivity and speed of the electrocardigraphs in 1906 when he demonstrated his String Galvanometer at 10 mm/mV and a speed of 25 mm/sec. His electrocardiograph is still the standard that today's electrocardiographs have to meet to pass or fail, since none of them are as accurate and sensitive. It has no moving parts to print the electrocardiogram, and the response of the string in the magnetic field is free of any significant inertial forces.
Since the mid-seventies today's electrocardiographic art requires twelve leads: the three standard leads of Einthoven, Leads I, II and III, described by Einthoven in 1912, the three Augmented Unipolar Leads of Goldberger, aVr, aVI, and aVf, described by Goldberger in 1942, and the six Precordial Unipolar Leads of Wilson, V1, V2, V3, V4, V5, and V6, described by Wilson et al. in 1034 (4. AHA 2007, page 1115, col. 2, line 29-page 1116, line 3). All the leads use the R, L, F electrodes to record the standard extremity leads and the nine unipolar leads. Goldberger connects two extremities with a wire and the wire to the third extremity, Wilson connects the three extremities through 5,000Ω resistors to his central Terminal and the fourth electrode to one of the extremities, or to electrodes placed on the chest at the six sites established by the American Heart association in 1938 (2. AHA 1938; 15: 107-108; 3. AHA 2007, Page, 1117, col. 1, lines, 6-11; col. 2, lines, 1-33)
Today's electrocardiographs have eight amplifiers and record two of the Standard Leads of Einthoven and the six V Leads of Wilson simultaneously. The calculator of the electrocardiograph calculates the third Lead of Einthoven and the three aV Leads of Goldberger. The connecting means have ten cables that are marked: R, for the right arm, L, for the left arm, F, for the left leg, G or RL, for the right leg, and V1 to V6 for each of the chest leads sites. Since they have a computer on board they interpret or read the electrocardiograms, average the electrocardiographic signals, measure the width and height of the different waves and segments of the electrocardiographic signals. The sensitivity, 10 mm/mV, the speed of the recording, 25 mm/sec., and the polarity of the standard leads, I, II, III, remain unchanged since 1913. The polarity of the unipolar leads and the placement of the V electrodes have remained unchanged since the American Heart Association implemented them in 1938. The following U.S. patents corroborate the above statements. (U.S. Pat. No. 1,882,402, page 1 lines 24-35, page 2 line 120-page 3 line 5); (U.S. Pat. No. 2,098,695, col. 1, lines 36-40, col. 1, line 48-col 2 line 1); (U.S. Pat. No. 2,229,698 page 1 lines 9-15 and 30-38); (U.S. Pat. No. 2,655,425, col. 1, lines 1-7 and lines 24-44, col. 3, lines 19-28, line 73-col. 4, line 3 and col. 4, lines 13-23); (U.S. Pat. No. 3,922,686, col. 2, lines 14-17, col. 1, line 66-col. 2, line 1); (U.S. Pat. No. 4,090,505, col. 1, lines 28-56 and col. 2, lines 22-27); (U.S. Pat. No. 4,121,575, FIGS. 1: 5, 7, 9, 10, 11, and 12, col. 1 lines 24-51); (U.S. Pat. No. 4,184,487, col. 1, line 64-col, 2, line 1, col. 2, lines 3-9 and lines 30-33); (U.S. Pat. No. 4,202,344, col. 1, lines 45-53); (U.S. Pat. No. 8,005,532. FIG. 1, FIG. 6); (U.S. 2003/0013978 A1, FIGS. 4, 5, and 6); (U.S. 2008/0255464 A1, FIG. 7)
An electrocardiographic trace is comprised of the following:                The P wave that represents the contraction of the auricle;        The PQR segment that represents an isoelectric state between the contraction of the auricles and the contraction of the ventricles;        The QRS complex that represents the depolarization of the ventricles and consists of the Q, R, and S waves. In a normal complex, one, two or all, waves can be present.        The ST segment that represents an isopotential state at the end of the QRS complex and the beginning of the T-wave;        The T-wave that represents the repolarization of the myocardium;        The U wave is seen occasionally and has no clear genesis, but a negative U-wave is strongly suggestive of myocardial infarction;        The TP segment represents what is considered the real isoelectric segment of the electrocardiographic trace. It is the time when both the ventricles and the auricles are relaxed.        
3) Personal Research
Einthoven, after discovering his Law, LIII=LII−LI, assumed that if:                “the human body is represented as a flat homogeneous plate in the form of an equilateral triangle, RLF, s. FIG. 17.” (5. Einthoven 1913, par. 61, page 292)        A small spot, H, in the middle of the triangle, represents the heart We can also represent the matters thus that between two closely adjacent points in the spot H a potential difference is developed. The arrow drawn in the figure coincides with the line that joins these points and represents the direction of the maximal potential difference in the heart” (5. Einthoven, 1913, par. 62-63, page 293).        
Superimposing an equilateral triangle to an X-ray of the thorax demonstrates that the apex of the triangle only reaches the epigastrium, not the pubic synphisis, as is portrayed by Einthoven, Wilson and Goldberger. In rats and dogs do not reach even the myocardium. (14. Ordó{umlaut over (n)}ez-Smith 2008, page 11, FIG. 6).
The human body is not a                “flat, homogeneous plate in the form of an equilateral triangle”rather, the electrical potentials that occur on the surface of the body in synchronicity with the contraction of the heart are conducted to the body surface in the manner demonstrated by Katz, et al. (8. Katz and Korey, page 83, lines, 12-18; page 85, Table 1; page 90, Summary) That is by the close contact of the different structures of surface of the heart with the spinal musculature, the musculature of the anterior and lateral walls of the chest, the abdomen, and the diaphragm.        
The heart does not generate the changes of electrical potentials in or on the body as a dipole localized in                “A small spot, H, in the middle of the triangle” (5. Einthoven, 1913).        
In fact the auricles and the P wave are prevalent on:                In the right peri-clavicular areas;        The supra-sternal notch:        The lower left pre-sternal and precordial chest wall areas;        The epigastric area.        
The changes of electrical potentials generated by the contraction of the right ventricle are prevalent on:                The anterior surface of the cephalic two thirds of the right hemi-thorax.        
The electrical potentials generated by the contraction of the antero-lateral surface of the left ventricle are prevalent on:                The antero-lateral surface of the lower two thirds of the left hemi-thorax;        The left sub-axilar chest wall.        
The electrical potentials generated by the contraction of the postero-inferior surface of the left ventricle are prevalent on:                The left sub-scapular and left inter-scapular areas of the left hemi-thorax;        The left lower back, and        The lower extremities. (14. Ordó{umlaut over (n)}ez-Smith, 2008; page 11)        
The existence of Einthoven's dipole has not been demonstrated ever. On the contrary, Body Surface Mapping, done for many years, has demonstrated that the maximal or minimal potentials present on the anterior surface of the thorax at the time of the peak of the P, Q, R, S, T, and U waves are not represented at all on the posterior or lateral surfaces of the thorax (17. Taccardi, 1963, FIGS. 3d, 4a-c; 17. Taccardi, 1966, FIGS. 1c 1f and 3a-f: 16. Stilli, 1988, FIGS. 3 Pb-h, 6 QRSc-h and 6 ST-Td-h). A must if there was a dipole somewhere in Einthoven's plane, generating such changes. They have consistently demonstrated that the maximal and minimal potentials, at the instants of the peak values for the above-mentioned waves, are only present on the anterior area of the chest. A finding, that is impossible to happen if the potentials are generated by a dipole oriented in Einthoven's equilateral triangle plane as is accepted in today's electrocardiographic art. Studies with implanted dipoles have shown that the body is an homogeneous conductor of electrical potentials. (15. Powsner, E. R., FIGS. 2, 4-9, Summary, page 476).
Electrocardiograms with potentials similar to the potentials of the three standard leads of Einthoven, Leads I, II, and III, obtained by Wolferth, and Ordó{umlaut over (n)}ez-Smith placing the three standard electrodes on the surface of the left arm or just on the left shoulder would be impossible to obtain if the potentials were generated by a dipole placed somewhere within the heart. Those electrocardiograms demonstrate that the changes of potential present on the surface of the extremity are generated by other means (22. Wolferth et al 1941, FIG. 3, C1-C3, FIG. 4, A2, E2, FIG. 5, A2, B2, and C2, Summary paragraphs 6-8 pages 226-227; 14. Ordó{umlaut over (n)}ez-Smith 2008, FIGS. 1-4).
The assumption devised by Einthoven to calculate the electrical axis of the heart, within the years, became the basis for Wilson's and Goldberger's theories of their Central Electrodes of zero potential. Einthoven's Law is valid because of simple mathematics, as Goldberger demonstrated in the appendix of his article, (6. Goldberger, 1945, page 377 under sub-paragraph Appendix), and Ordó{umlaut over (n)}ez-Smith has demonstrated the validity of the law as the result of a mathematical axiom not as a result of Einthoven's assumption (13. Ordó{umlaut over (n)}ez-Smith 2000, page 154, equations 1-4; 13. Ordó{umlaut over (n)}ez-Smith, 2008, pages 9-10 equations 1-8 and FIGS. 1-4).
Einthoven's Law refers to the addition of the potential differences between the three standard leads and not to the addition of the potentials of the three extremities as Wilson assumes. In order to obtain a zero potential by adding the potential differences between the three extremities at the peak of the R-wave, one or two of the values would have to be negative and equal to one or the addition of the positive values, a fact that is against the First Law of Kirchhoff, also known as the Law of the junctions:I1+I2 . . . +In-1+In=0  (1)
That Law states that the addition of the currents into a junction is equal to the addition of the currents out the junction. The electrons flow from the negative pole to the positive poles. The electrons into the junction have a positive sign and the electrons out the junction have a negative sign. To measure a drop of potential, the positive terminal of the voltmeter is placed on the highest positive potential and the negative terminal on the lowest potential. Within the circuit formed by Wilson's three resistors the current will flow from the extremity with the highest negative potential to the extremities with the lowest negative potentials or the highest positive potentials.
At the peak of the R wave the right arm has the highest negative potential (17. Taccardi, 1963. FIG. 4b), and the current flows into the junction (central terminal), a series circuit. All the electrons that flow through the resistor, connected to the right arm, go into the junction. From the junction (central terminal) the electrons leave the junction through the resistors connected to the two left extremities, a parallel circuit, with a higher positive potential. A 5,000Ω resistor in a series circuit keeps its value; two 5,000Ω resistors in a parallel circuit have the conductivity of a lesser resistance. Since the two extremities do not have the same potential, the extremity with the highest positive potential will have the greater flow and the other a lower flow. The rule of voltages in a parallel circuit state that the drop of potential of the parallel circuit is equal to each of the drops of potential within the circuit:Vt=V1=V2= . . . =V(n-1)=Vn  (2)
The current flowing into a junction that leaves the junction through a parallel circuit of two equal positive voltages and resistances will leave the junction with half of the current going through each resistance:I1=I1/2+I1/2  (i)
According to equation (2) the drop of potential of the entire parallel circuit is equal across all the resistors in the circuit. The drops of potential across the series circuit and across the parallel circuit are not equal:5,000I1≠5,000I1/2  (ii)V1≠V1/2  (iii)
The voltages in equation (iii) are both positive. A fact, that goes with the Second Law of Kirchhoff.Vt=V1+V1/2  (iv)
Within the circuit formed by the three resistors of Wilson, Vt is equal to the addition of the drop of potential across the series and parallel circuit,Vt=Vseries+Vparallel  (v)
Equation (iv) and (v) demonstrate that there is no place for the assumption that a dipole can generate the changes of potential associated with the heartbeat on the surface of the body. All the drops of potential across the three resistors of Wilson have to be positive. The electrical potential of Wilson's Central Terminal is equal to the total drop of potential of the circuit, minus the drop of potential of the parallel circuit (14. Ordó{umlaut over (n)}ez-Smith, 2008, FIG. 11, right lower diagram), o equal to V1 in equation (iv) or to Vseries in equation (v). A value between, lower than Vt/2 and 2Vt/3 depending on the potentials in the left extremities. Far from zero or near zero as assumed by Wilson. The potentials of the left extremities are, according to the Body Surface Maps, less negative or more positive than the right arm (17. Taccardi, 1963. FIG. 4b).
Equation (4) of Wilson has mathematical and physics errors:(VA−VT)+(VB−VT)+(VC−VT)=r(IA+IB+C)  (4)                (21. Wilson et al. 1934 page 449, last line)        
The left side of the equation was calculated assuming that all the currents go into the junction (21. Wilson et al. 1934 page 449, last sentence of first paragraph after subtitle Potential of the central Terminal), an assumption that goes against Kirchhoff's First Law that states that any current that goes into a junction has to leave the junction. The left arm of the equation, written according to Wilson's FIG. 1, demonstrates that Wilson really believed that all the currents went into the Central Terminal no current went out of the junction:(VR−VT)+(VL−VT)+(VF−VT)  (vi)
According to Kirchhoff's First Law, the current passing through the resistance connected to the right arm is equal to the addition of the currents leaving the junction. Since the potential of the right arm is lower than the potential of the central terminal:−(VR−VT)=(VL−VT)+(VF−VT)  (vii)
Expressing the voltage in function of resistance multiplied by intensity (Ohm's Law):−RRIR=RLIL+RFIF  (viii)
Eliminating the value of the resistance we have:−IR=IL+IF  (ix)
The algebraic addition of the currents going through the junction, following the rationality of equation (4) of Wilson, will be:−IR+−(IL+IF)≠0  (x)
Since VT is connected to the negative terminal and VT is positive with respect to VR, the value of (VR−VT) is negative, but the currents out the junction to the left extremities, VL and VF, are positive with respect to VT and are recorded as positive. It can be said, without any error, that Wilson's assumption expressed in equation (4) does not follow Kirchhoff's First Law.
The right hand side of the equation does not take into account the fact that resistors in series keep their value, but resistors in parallel do not. In a series circuit the total resistance is:Rt=R1+R2+ . . . R(n-1)+Rn  (3)
In a parallel circuit the resistance is equal to:Rt=1/R1+/1R2+ . . . +1/R(n-1)+1/Rn  (4)
A mathematically and physics correct right arm equation is:5,000IR+<5,000(IL+IF)  (xi)
Since according to Kirchhoff's first Law, IR is equal to (IL+IF) the right arm of the equation is not equal to zero either. The resistances are not equal, the resistance in the series circuit has a value of 5,000Ω but the two resistors of 5,000Ω in the series have a value inferior to the 5,000Ω. It could be between 2500Ω and less of 5,000Ω. As a consequence, it can be said, without any error, that all formulas derived from Wilson's equation (4) are wrong.
As can be appreciated from the foregoing discussion there is a very strong evidence demonstrating that today's accepted electrocardiographic theories are not valid. There is a need of having a better way to record and analyze the electrical potentials generated in association with the contraction of the heart. Some of the researchers with a similar view are: (23. Wolferth, et al. 1944, Summary 2. pages 780-781; 10. Nahum, 1951 FIGS. 3 and 4, Summary, page 177; 15. Stilli et al., 1988, FIGS. 3-8; 19. Taccardi 1990, pages 150-151, second to fourth paragraphs; 18. 1966, FIGS. 1-3; 16. 1963, FIGS. 3-5; 9; 9. Mauro A. et al., 1952, FIGS. 1 and 2, page 590, Summary, 9. 1953, FIGS. 1-4, page 794, Summary; 15. Powsner, E. R., FIGS. 2, 4-9, page 476, Summary,).
Since today's so called unipolar leads are bipolar, the new method consists of obtaining from 15 to a 100 Bipolar, Non-Vectorial, Truncal Electrocardiographic Leads, by standardizing the leads to a common positive electrode placed on the left leg and placing the negative exploring electrodes on: the right peri-clavicular area, supra-sternal notch, the anterior surface of the chest, epigastric area, left lateral chest wall, right and left axilar areas, right upper posterior axilar area and on the left posterior para-spinal area where the potentials generated by the heart are more prevalent and calculating twelve to thirty second derivatives pairing and subtracting the minimal from the maximal values recorded by the leads at the mid-ascending, peak and mid-descending values of the different waves, P, Q, R, S, T and U and at the PQR segment, RST segment, TU segment and TP segment. The use of exploring negative and common positive electrodes would facilitate the interpretation and analysis of the changes generated by the contraction of the heart.